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Home My WebLink About12-06-06 -I 15056051047 REV-1500 EX (06-05) PA Department of Revenue Bureau of Individual Taxes PO BOX 280601 Harrisburg, PA 17128-0601 ENTER DECEDENT INFORMATION BELOW Social Number Date of Death INHERITANCE TAX RETURN RESIDENT DECEDENT Date of Birth Decedent's Last Name Suffix Decedent's First Name MI (If Applicable) Enter Surviving Spouse's Information Below Last Name Suffix MI Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW _ 1. Original Return c:::> 4. Limited Estate c:::> 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required c:::> 2. Supplemental Return c:::> c:::> c:::> 4a. Future Interest Compromise (date of death after 12-12-82) c:::> 7. Decedent Maintained a Living Trust (Attach Copy of Trust) c:::> 10. Spousal Poverty Credit (date of death c:::> 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. 0) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number 6. Decedent Died Testate (Attach Copy of Will) 9. Litigation Proceeds Received o 8. Total Number of Safe Deposit Boxes .. .J A t~ EJ' J "lZ, (Lv 2- bA 1.\1 ,t::l, )\ (' r A~~ AJ -I DC I 4-rt_i REGIS~~ OF WILLS ~ ONLY Firm Name (If Applicable) ~ 1..,,-, ' ~, \ y-r LL c..... ",:;' \ J- UJ...... fv\ A v'\) ~(L 'P g. I V e Second line of address I vI -r t l \) ,;:) City or Post Office ~I\ t: <.... H A Iv ( c_i U u f2-6 I 0"'\ First line of address '-::1 r.~ {-~) State ZIP Code 'fli~ FILED fJA I I (./ JJ- <.::> Correspondent's e-mail address: Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowiedge. SIGNATURE OF PERSOl-l RESl'lONSIBLE FOR FILING RETURN " DAjfE I (\ ,\' 1,1,)),1:.: ,r'i) Co, cr',. 1 L..," Lit I"') it I." i \.j {l....v Ct, '1".. ''''C---'-Y ...... r ~.C '-^-C' 0-) -' I..... I Vi,(') ADD~SS . I < _S-\) J ~; 2~\cj(7'- '\) "':\'-'C c.eo" LJl, fA PREPARER OTHER T~~PR~SENTATIVE ,p I \ )} . ~, I C ,A. _fu~~'^ CJ ~_-1> ,,: \iiC \ _iv',rK \O~', i~t? L L, c.-. ",', PLEASE USE ORIG'NAL FORM ONLY It, ~ 1) DAJF lLla/~(. P:A- \ , s. { f- ADDRESS b Iv Y'J Side 1 L 15056051047 15056051047 ....J ~. .-J 15056052048 REV-1500 EX Decedent's Social Security Number Decedent's Name: (f?(lJ(.. \ 2: I' (, \L l~c'lL \8 C{ \ 0 11]l{8 RECAPITULATION 1. Real estate (Schedule A). 1 V0, \) Nt 2. Stocks and Bonds (Schedule B) . . ." .. . .. 2. l\l 0.N t? . 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) . . . 3. ~u /V'C . 5. !v0/V (ltc{ ---- t::::' . 4. Mortgages & Notes Receivable (Schedule D) . 4. 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) . . . \ f'. Itj 6. Jointly Owned Property (Schedule F) C=> Separate Billing Requested . 7. inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) C=> Separate Billing Requested. . 6. No ,A.) E . 9. Funeral Expenses & Administrative Costs (Schedule H). . 9 \'"1 ~)-l.yj ~ l J-"1 '{ '2-. -.rq \ S S-rq .el \ \.{, '-\ .-"1 '1 lS(c~.8"1 \ -f1 0 J ~ .l 0 /VD/V0. 7. 8. Total Gross Assets (total lines 1-7). . 8. 10. Debts of Decedent, Mortgage Liabilities, & liens (Schedule i) . . . . 10. 11. Total Deductions (total lines 9 & 10). . . . 11. 12. Net Value of Estate (line 8 minus line 11) . . . 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) . . . . . . . . . . . 12. . . . . . 13. 14. Net Value Subject to Tax (line 12 minus line 13) . . . . . . . . 14. \ 11 0 3 ~.} 8 TAX COMPUTATION - SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .0_ 16. Amount of line 14 taxable at lineal rate X.O ~~ 17. Amount of line 14 taxable at sibling rate X J 2 18. Amount of line 14 taxable at collateral rate X .15 ~I\) 0 .fV 'f" ~ fl 03 . .---- II.} :) IV 'C . 15. . 16. I D b& .[J 17. . 18. . 19. LO b fc .'1, J -3.Ii' [v~ (IJ E- . 19. TAX DUE. . . . . 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT - Side 2 L 15056052048 15056052048 .-J Decedent's Complete Address: DECEDENT'S NAME File NUmbj I ~ ;l () 0 l:.- c u\-\ \. \ REV-1500 EX Page 3 STREET ADDRESS u.e/ c I c:!: "'L \L _ l~C\L II 3 J . ~ " ~~~-Lj LX' D ;, 'v'-<- CITY CC,.,.\:1/-t STATE fA ZIP \'\(:) U Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) -=1 D b h _~ J 0,000, VJ 3_L~ 3 'l Total Credits ( A + B + C ) (2) :51 3 [~.3 Lf_ 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty ( D + E ) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, Line 20 to request a refund. (3) o 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (4) __J;bf-h ,_rq (5) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5A) (5B) A. Enter the interest on the tax due. Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. ~.idr~~a~~~~:\::~ ~n~:~~:f ~~~:property transferred; .......................................................................................... 0 ~ b. retain the right to designate who shall use the property transferred or its income; ................................... D G-(' c. retain a reversionary interest; or.................................................................................................. D ~ d. receive the promise for life of either payments, benefits or care? ...................................................... .... .... D G:r' 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ........................................,.............. ...............................'........'... 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? .................................................................................................. .....~ D ............ ~ [-I o D IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is three (3) percent [72 P.S. S9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is zero (0) percent [72 P.S. S9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is zero (0) percent [72 P.S. s9116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is four and one-half (4.5) percent, except as noted in 72 PS. S9116(12) [72 PS. s9116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [72 P.S. s9116(a)( 1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-1508 EX + (1-97) SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF b €-v'"ic. \ ~ ~ ,^L '?-- . ~,[lL FILE NUMBER 1-1 - )--006 - GOYII Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1. J-. '3 '-\ f. G. f "6. ~ \ -J, DESCRIPTION j '-'1 ~ " c '^.t. ,\ /'1t, \,: t> \ '- i'1 ~ b...l '- \. C v{ <L -\- L'; V\, , ;)/,\ '"'" J'v- _d" 11)00 \./ {, \ v L, 1 ({.. c..-\1?, Ll..L J h",vt'. Alct \ I b <11'\ \i. [ i'~ VALUE AT DATE OF DEATH leI j(,,=1 J' '1 "1 '1 .) . ;:):..) , J- 1. 'l tt {j (n 10 If'll. 3 I \ (".-,.f\ 3.tf(, ). j> D':). ..:.;,) \ I 1,)? , Q-.J I 1\:':)> ..;:> I} l"~' :) ~ U c' J-.q~1 I~Jl~tl....(v1-'" \,1'/\\-f_'1 ~~~J~\ C.A..!.:\- U"'>'~I ((or'-\-..A DfJO~'lt( ':l\=O-3'11-- J-3S I l)ov \.;(...1'--'(.., Ju ({*(~L '\:',~k Ltrttc--. J,..dt vt~'-lv"-C. \iu-\\~'J Ule/,L C'd.:-\- l\I\.:':J-^1 0---?<,~'j (h\o-, Azc~. ;:t:tJ '11- -~S' I l) ~ \) 'V ... \ v ( j e e Gt ...f'"'\l' ( ~ L 6 v\ Ie I LYk v .J'-'J1~Ck(,^"",<. Lju\\ <j \ft.h1dl-\ C--cl~.\-- \..).":-::J.,, I c.tv'~[:"'5 ~(D':~+( *'")'12-. '1'-' ,'D "'J) VG-l\v( I fe.e C<~lIr-eL ~ l......\L \ ",tk/ )VJ1,-, t,~c. ""N' \,, {~\":.Y ~ij./< ( L.,,-.d-;-\- U V\"J.^ I Cfl ,k, A I)(~:'>l~~ I ~3~).. -S" t ')).;:.; \) \it \.... c J {,.e. c,~ l ~'-( l. be....., IL I~ I l L1 t; (1' r. l l CT - ~f I..) 0 r \{ 1-'1 f C..r .;.117- L \;'-1 2 [,)~ p r (\; ) (,. L \ C1 (l r ~D'J ",--t\ /...L. t" ,/\-"\ C'." : \ \" I 10.... <.rhc h'-/ ~ <^ f P ,r (.., ,Jc.l \ [\ q ) U'I ----......... ~\ \ ..r:J.-. I I . \LYIIl/1- ....&.Il2.v (t/,;.'rw(~-cc. I (. rl.it-:.JJ Ivc.ve\c.l) ~~v\l'1,^6t en}1-\) \\-..\C'iI'6/\le... I,-CL.....L /\2-. f (, GI!./ ') \) ~j { ./-.lc- .j'( {'" ~L TOTAL (Also enter on line 5, Recapitulation) $ \ (4 q l r. \ I'f (If more space is needed, insert additional sheets of the same size) REV-1510 EX + (1-97) SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF ?" , . be "... \ G.",c I( . ++L Ie FILE NUMBER ). I .. 1 000.,'- 00'-\"'\ I This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. ITEM NUMBER 1. DESCRIPTION OF PROPERTY INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND THE DATE OF TRANSFER ATTACH A COPY OF THE DEED FOR REAL ESTATE. DATE OF DEATH VALUE OF ASSET %OF DECD'S INTEREST EXCLUSION TAXABLE VALUE IIF APPLICABLE) (c, j l. C\;-(-\-::r -tc J.ov~ \r\\c/ .(/Igl~ - \l-\JI/:t;. .~ 'j I c;A'IT,l~-U_ .JlN Lt{. ~vr bt?~ I \ r \ -J.:J :;)/) \ \ -: D .) \ 1.,).:..)',) "X'> \ :t-, \ '-='~,) . J .J ,1 e t' )... CD. J k:/ f.-tJ -tu J {. ( t;~,d'{ 2. d h<5 h. 4v' )c/,dv\c. II \ 1--'10 - 11 n 1"'0 I ~v JrJ7.~ I Sllv..?J?) 10 :,) J\ 00) ~;) ).., \ "0 ,).J :L C CJ k ,5,I1:J -to -tn' (~j, j11 i I ::u'- ,:1-13 110); Je. e. c:"_~, ( If L il h..( 2v Ie +,..--- ).€-tz.', j :> ,Y It. .;.)0-') \ <lJ 3, () 0:),)) qJD J:J [J -;\J.- ') \.." 1- - \ I \ S \J.l < 'V (' h..c/\ "'... '-\ :r:. \'- /'\ (.; C{ C' 'V ",.Ie. ) I I " \,.i (. \ \ ~J h 2..(:' \1'<-- \ {i.... L-\-- \J t^-~?'" I J (. '" j \.... x" I ) ~ t v- e ~ (: : "::'~ , J (' e Ct~. l ~ L. b 6"- k- I C' 1te v ).., b 11 '1.( I J:) J-, G 11 'tJ TOTAL (Also enter on line 7, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) \\ XLI '-if' REV-1511 EX+ (12-99) . ~,~,~ .~.~~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ~o('./'^ \J:.,r- C- lL H '.H.- It- FILE NUMBER )- \ ~ J- v .) Ie ~- 0 (:) '-Il I ESTATE OF Debts of decedent must be reported on Schedule I. ITEM NUMBER A FUNERAL EXPENSES: DESCRIPTION AMOUNT 1. 'r-vv---<1:.".\ ~f'\--t'_, V')c.v'\h.t:~y\"\n"j\ tUi''-V C'-':1-~-t'../\t-,,~-\ PA t=' I,; '.--Lv J -fo.- ~ '^~. ,/. I 81~ l ",.1..0 }- /1_ "-'-J ~ t-v,^<vc\ tv"(.~'("" C.,,--\-C-VI"j .- (;,;<-/\-\-10",,); J- I J .) 3 B ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) c _ .J r\ -n: c. A. \S. I {,v ( '" I 6 '-/ - f).. ~ ,y fl (, . RJ. State .f.lL- Zip \ '1;,:) I 3 D Social Security Number(s)/EIN Number of Personal Representative(s) Street Address J"', 1 J. I~: ~ ~ l ( J <. )<. City L<_ /1. I I L- Year(s) Commission Paid: tJlA o 2. Attorney Fees 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Street Address c 'j /\ "'-' i-. rl) J t4 \<:,\u,,-,(I... ,0--.. J ~ le.J -Lx ~ (b 0 Y> \ Claimant City c< ... \. J \'l 1(2) State fA Zip 1-(aU Relationship of Claimant to Decedent lJ <'----,5 h~~ 4. Probate Fees ? J''c . UD 6. Tax Return Preparer's Fees GJ-\- <'r- ~ A?~ 0 L', .,-\c) , LL L .---ol :0 I) (\ \ ^ ( .- 1-. .". v-t'+~ / "'-) c; t'~ f (.,/ C. .~. r- , - w--.....--<L" ~ r- )-, c;::;-? 00 5. Accountant's Fees 7. Atvt ,..-t\ .l;.r-j .(.0 r e. J-17. k t:-J--\7, -Ie (\y(\L) ~.... S c' It Co (U.' -.J _",---t- Jl ~-e2~'.r--J b~ levl,:,) o'{ Jii (2<v'-\.'f d'Jp-~j-(2. fC,ftv-J ). fl' -'>0 lSq \ 2. ,y. (I ~ Y).'1.'i8 TOTAL (Also enter on line 9, Recapitulation) $ \~ f(q. 07 (If more space is needed, insert additional sheets of the same size) REV.1S12 EX... (1.97) SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF be-V'i' \ ~: I'-e: 1(, ~ L\L FILE NUMBER J-l- )-""'''''.(, r 00 l(ll Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION AMOUNT 1. S f ./ ,'" ~ ) (Il.- \.: v \" -~''''L' \ ---h: l ( ~ k'V'-L L, \ \ \j y 1.1 Lf )- W (: J \ .J h p./'L f- /1.--, j C,.V- ~...J\i,v'(C J~VVI CL 10] v"? TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) \ ~1 '"' ,-[ 'i REV-1513 EX+ (9-00) ~~_ ~ SCHEDULE J BENEFICIARIES COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER J..-I ~ J-- Q:; f. u u L/ll C,€ ,/c. \ C: 1'-<'_ \( , \--k t It- NUMBER I RELATIONSHIP TO DECEDENT NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1. A .~ \ t.-.} ck.. C'j ,'- i" ~ " I, (u J ~t : ~ ~ \ {J L(< K O(.~ 1) t. v j k-vv C4Y\'Jlt PA \ 1\ u \J AMOUNT OR SHARE OF ESTATE ~) \ O:.J ~ ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET II NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. B CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ (If more space is needed, insert additional sheets of the same size) Estate of Geraldine K. Hock File Number 21-2006-00471 Attachment to Inheritance Tax Return Schedule G. Line 1. Cash gifts to daughter from 5/18/05 to 12/31/05: 6/04/05 $ 700 6/26/05 1,000 7/6/05 700 8/2/05 700 9/2/05 700 9/1 0/05 5,000 10/1/05 700 11/1/05 1,500 11/4/05 700 11/12/05 1,500 1213/05 700 12/25/05 1,000 8/26/05 200 Total 15,100 Line 2. Cash gifts to daughter from 1/1/06 to 5/17/06: 1/2/06 $ 1,500 1/3/06 700 1/8/06 1,500 3/27/06 700 4/23/06 700 Total 5,100 Continued on following page Estate of Geraldine K. Hock File Number 21-2006-00471 Attachment to Inheritance Tax Return Schedule G. (continued) Line 3. Cash gifts to friend from 5/18/05 to 12/31/05: 5/19/05 $ 500 6/4/05 300 6/14/05 300 7/6/05 300 7/21/05 350 8/2/05 300 8/26/05 500 9/2/05 300 10/1/05 300 11/1/05 300 12/3/05 300 12/21/05 100 12/25/05 100 Total 3,950 0_ 7-06; 2: 17PM;GIA~JT MKTG ; 1 # 4/ 2 ~ SUSQUEHANNA ALLEY FEDERAL CREDIT UNION June 6, 2006 Cynthia A. Blauch 513 S. Middlesex Road Carlisle, Pa 17015 Re: Geraldine K. Hock, deceased SSN: 189.18-5848 Dear Ms. Blauch: Following is the date of death information on the accounts for Geraldine K. Hock at this credit union. There were no joint owners on any of the accounts. Acct No. Type Balance Accrued Total Interest Value 342.00 Shares $ 10,544.11 $ 13.58 $ 10,557.69 342.23S Certificate $ 84,588.17 $154.83 $ 84,743.00 342.35 MMA $ 27,771.12 $ 28.85 $ 27,799.97 342-40 Checking $ 10,571.31 $ 00.00 $ 10,571.31 342-51 Certificate $ 16,486.29 $ 27.57 $ 16,513.86 Totals $149,961.00 $224.83 $150,185.83 In addition to the above, there is an IRA account with a date of death balance of $2673.18 and accrued Interest of $4.27 for a total date of death value of $267745. If tllere are questions, feel free to call. Sincerely, )(~/~ , ,/ Larry L. Stoner President/CEO 3850 HARTZDALE DRIVE · CAMP HILL, PA 17011-7809 LOCAL: (717) 737-4152 TOLL FREE: (800) 948-1454 FAX: (717) 737.0589 ~q~ .~ --....,._--_./ 2- -,~ -06; 2:: ,PM; C.:; I ,A,j.JT I\\KTG ; 1 # 5/ 8 w~ 5kM, $ SUZUKI Phone: (717) 697-3099 Fax: (717) 697-3169 June 2, 2006 Cynthia Blauch 513 S. Middlesex Rd. Carlisle, P A 17015 To whom it may concern: The estimated value of model L T -F500F 4x4 year 1999 is $2,800.00 (Vin #JSAAM41A3X2105972) 1?~ Bill Toth West Shore Suzuki 5203 East Trindle Road · Mechanicsburg, PA 17050 8- 7-06; 2: 19PM;GIA~JT MKTG ; 1 # ~~ 3 DAN'S FRAME SHOP 6493 Carlisle Pike MECHANICSBURG, PA 17050 (717) 697-4122 ~D~ -1}b 59394 DATE PAOMISED LICENSE NUMBEA MOTOR NUMBER ODOMETER /JjJ1;1'6tf!o~~: ~~~t1W~ LITERS/GALS. OF GAS @ TOTAL LABOR (MAY BE CONTINUED ON OTHER SIDE) TOTAL PARTS L1TERSlQTS. OF OIL @ k ILBS. OF GREASE @ TOTAL PARTS I hereby authorize the above repair work to be done along with the necessary materials. You and your employees may operate above vehicle for purposes 01 testing, inspection. or delivery at my risk. An express mechanics lien is acknowledged on above vehicle to secure the amount of repairs therelo. It is also understood that you will not be held responsible for loss or damage to cars or articles left in cars in cace of fire. theft or any other cause beyond your control. SIGNATURE ACCESSORIES GAS. OIL AND GREASE SUBLET REPAIRS EPAI WASTE DISPOSAL ACCESSORIES TAX TOTAL ACCESSORIES TOTAL THANK YOU s~ 06; 2: 19PM;GIANT Mf<TG ; 1 # A- 2 DAN'S FRAME SHOP 6493 Carlisle Pike MECHANICSBURG, PA 17050 (717) 697.4122 MER / ...." Z - Of;, 59395 EXT. DATE PROMiSED LICENSE NUMBER ODOMETER . ~;J7f:kJ!..:A~i ~ ilAJ~ ItJH. .... ....n~A1;.i1Ji"~J/; WOe _. .~}'IJIY1-~ttf- ~.OD~~ ... LITERS/GALS. OF GAS @ TOTAL LABOR (MAY BE CONTINUED ON OTHER SIDE I TOTAL PARTS L1TERS/QTS. OF Oil @ k /LBS. OF GREASE @ TOTAL PARTS I hereby authorize the above repair work to be done along with the necessary materials. You and your employees may operate above vehicle for purposes of testing, inspection, or delivery at my risk. An express mechanics lien is acknowledged on above vehicle to secure the amount of repairs thereto. It is also understood that you will not be held responsible for loss or damage to cars or articles left in cars in case of fj re, theft or any other cause beyond your control. SIGNATURE ACCESSORIES GAS, OIL AND GREASE SUBLET REPAIRS EPA I WASTE DISPOSAL ACCESSORIES TAX TOTAL ACCESSORIES TOTAL THANK YOU LAST WILL AND TEST AMENT OF GERALDINE K. HOCK I, GERALDINE K. HOCK, currently a resident of and domiciled in Lemoyne Borough, Cumberland County, Pennsylvania, do hereby make, publish and declare this to be my Last Will and Testament, hereby revoking all Wills and Codicils at any time heretofore made by me. ITEM I: Personal Effects. I give and bequeath all of my tangible personal property, exclusive of any such property used in a trade or business, together with all policies of insurance thereon, to my daughter, CYNTHIA A. BLAUCH, or if she does not survive me, to her issue who survive me, per stirpes. If my daughter disclaims any portion of this bequest, the disclaimed portion shall be distributed as part of the bequest to my husband under Item II of this Will. I request that my daughter abide by any memorandum by me directing the disposition of this property or any part thereof. This request is precatory and not mandatory. ITEM II: Specific Bequest. If my husband, GORDON F. HOCK, survives me by one hundred fifty (150) days, I give, devise and bequeath to my husband cash, securities or other property of my estate having a value equal to the amount, if any, that my husband would be entitled to receive if my husband exercised his elective share rights as set forth in Section 2201 et seq. of the Pennsylvania Probate, Estates and Fiduciaries Code; provided, however, the amount of this bequest shall be reduced by the value of all property and interests in property passing to my husband as a result of my death other than pursuant to this bequest. My Executor shall have the sole discretion to select the assets which shall constitute this bequest. This bequest shall be distributed, in trust, to my hereinafter-named Trustee to be administered as provided in the following subparagraphs of this Item. If my husband does not survive me by one hundred fifty (150) days, or in the event my husband (or his legal representative) disclaims any portion of this bequest, the same shall be distributed as part of the residue of my estate. (a) My Trustee may pay to or apply for the benefit of my husband during his lifetime such sums from the net income or principal of this trust as in its discretion shall be necessary or desirable from time to time for his medical care, support, and maintenance in reasonable comfort, or for any other reason my Trustee deems appropriate. Any net income not paid shall be accumulated and added to principal. Upon -1- the death of my husband prior to complete distribution of this trust, the then remaining principal and accrued income shall be distributed pursuant to Item III of this Will as if I had then died. (b) Whenever my Trustee makes a distribution, it may be paid out in such of the following ways as my Trustee deems best: (1) directly to my husband; (2) to my husband's legally appointed guardian or attorney-in-fact; (3) to some relative or friend for the care and support of my husband; (4) or by my Trustee using such amounts directly for my husband's care and support. My Trustee shall have no further responsibility for funds so paid. ITEM III: Residuary Bequest. I give, devise and bequeath all the rest, residue and remainder of my estate to my daughter, CYNTHIA A. BLAUCH, or if she does not survive me, to her issue who survive me, per stirpes. ITEM IV: Executor. I appoint my daughter, CYNTHIA A. BLAUCH, as Executrix of this Will. If she is unable or unwilling to serve or continue to serve, then I appoint my son-in-law, DENNIS D. BLAUCH, as Executor. ITEM V: Trustee. I appoint my daughter, CYNTHIA A. BLAUCH, as Trustee of the trusts created hereunder. If she is unable or unwilling to serve or continue to serve, then I appoint my son-in-law, DENNIS D. BLAUCH, as Trustee. (a) The then acting Trustee shall have the power to appoint at any time and from time to time any person or bank or trust company to act as successor Trustee in the event that the initial Trustees shall be unwilling or unable to serve or continue to serve as a Trustee. (b) Whenever a bank or trust company is serving as Trustee hereunder, the beneficiary of any such trust (or such beneficiary's authorized agent or legal representative) shall have the power to remove such Trustee and replace the same with some other bank or trust company to act as successor Trustee. The successor must be a bank or trust company related or subordinate to any trust beneficiary within the meaning of Section 672( c) of the Internal Revenue Code. The removal shall not be effective until a successor has accepted its appointment. (c) Any successor Trustee shall have the same powers, duties and authorities as though named hereunder as an original Trustee. Any successor Trustee shall be exempt from any liability in any way related to the prior actions or omissions of the Trustees -2- -_.~ hereunder, and each shall be entitled to accept as conclusive any accounting and statement of assets furnished by any predecessor Trustee. (d) Any removal, resignation, appointment or acceptance of trusteeship shall be made by written instrument duly signed, acknowledged before a notary public and filed with the records of the Trust. Any Trustee may resign at any time without court approval~ provided, however, if the resigning Trustee was serving as sole Trustee, such resignation shall not be effective until a successor has accepted an appointment as Trustee. (e) Notwithstanding any provision herein to the contrary, no Trustee may participate in the exercise of any discretion to distribute principal to himself or herself other than for his or her health, education, support or maintenance, nor may any Trustee participate in the exercise of any discretion to distribute or expend principal or income to satisfy any of the trustee's personal legal obligations for support or other purposes. ITEM VI: Fiduciary Powers. All fiduciaries (which term whenever used herein shall include my Executors and Trustee and their successors) serving hereunder shall do so without bond or other security in any jurisdiction. In addition to powers given them by law, all fiduciaries acting under this, my Last Will and Testament, shall have the following powers, applicable to all property held by them, effective without court order and until actual distribution: (a) To retain any or all of the assets of my estate or trust, real or personal, without regard to any principle of diversification or risk~ (b) To sell at public or private sale, to exchange, or to lease for any period of time, any real or personal property and to give options for sales, exchanges or leases, for such prices and upon such terms or conditions as they deem proper~ (c) To invest in all forms of property (including stock, common trust funds and mortgage investment funds whether maintained by my corporate fiduciary, if any, or others) without restriction to investments authorized for Pennsylvania fiduciaries~ (d) To make distribution in cash or in kind, or partly in cash and partly in kind, and in such manner as they may determine, and at valuations finally to be fixed by them~ (e) To allocate receipts and expenses to principal or income or partly to each as they from time to time deem proper in their discretion~ (f) To engage in litigation and compromise, arbitrate or abandon any claim~ (g) To borrow money from any person or institution, and to mortgage or pledge any or all real or personal property as they in their discretion shall choose, without regard for the dispositive provisions of this instrument~ (h) To continue and operate any business owned by me at my death for such time as my fiduciary shall deem advisable~ -3- (i) Power in my executors to disclaim on my behalf any property or interest in property which would otherwise have passed to me by any means prior to my death. (j) Power in my Trustee to combine assets of two or more trusts (including trusts created by third parties) if the provisions of each are substantially identical, and to administer them as a single trust, if my Trustee reasonably deems it appropriate and the combination is consistent with my intent, and facilitates the trust's administration without defeating or impairing the interests of the beneficiaries. (k) In general, to exercise all of the powers in the management of my estate which any individual could exercise in the management of similar property owned in their own right, upon such terms and conditions as my fiduciaries may see best, and to execute and deliver any and all instruments and to do all acts which my fiduciaries may deem proper or necessary to carry out the purposes of this my Will, without being limited in any way by the specific grants of power made, and without necessity of a court order. ITEM VII: Spendthrift Clause. Except as otherwise provided herein, all payments of principal and income payable, or to become payable, to the beneficiary of any trust created hereunder shall not be subject to anticipation, assignment, pledge, sale or transfer in any manner, nor shall any said beneficiary have the power to anticipate or encumber such interest, nor shall such interest, while in the possession of my Executor or Trustee, be liable for, or subject to, the debts, contracts, obligations, liabilities or torts of the beneficiary. ITEM VIII: Beneficiaries Under 21. If any share of my estate becomes distributable to a beneficiary who has not attained the age of twenty-one (21) years, then the same shall be paid to a custodian for the beneficiary under the Pennsylvania Uniform Transfers to Minors Act. The custodian shall be selected by my Executor, and may be my Executor or the minor's parent. The receipt of the custodian shall be a full discharge of my Executor. IN WITNESS WHEREOF, I have hereunto set my hand and affixed my seal to this, my Last Will and Testament, consisting of four (4) pages, this J 11ft day of HI'<\, ,2001. // f ~ A I;;. I , .pr!~ . rj~ 7-/ 1"'f~ .1kl/ GERALDINE K. HOCK (SEAL) -4- .., SIGNED, SEALED, PUBLISHED AND DECLARED by the above Testatrix as and for her LAST WILL, in the presence of us who thereupon at her request, in her presence and in the presence of each other have hereunto subscribed our names as witnesses: d~ fl4l!r Name !/!. rk P IJ A ress y O~r f'/J- Addfess COMMONWEALTH OF PENNSYLVANIA ) ) SS: COUNTY OF YORK ) I, GERALDINE K. HOCK, the Testatrix, whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will; and that I signed it willingly and as my free and voluntary act for the purposes therein expressed. Sworn to or affirmed and acknowledged before me by GERALDINE K. HOCK, the Testatrix, this J<6~ day of ~ ,2001. ~ ~~~ <RLJ< Not ry Public ~ ) A i ! /i?;,.;, r,) ,1 . 't<' ::;:-!~- ;' _. T -"\ T' ;..,} (. ...-- GERALDINE K. HOCK Notarial Seal Mlol1@la L. Ramp, Notary Public York. York County Mv Cotnf1llst;I(jl'\ Expires Oct 13, 2001 y_O .._... -....- ~. -5- '1" -".. '.'~' 'r" :ttl_- -..;.....~- ""-"-", '~H."~."',c;-"!l.'- ..''''''...(.......'. .,-"""vh'-'."j:~':&~;';;"',";,,,, il&~r~~f;:c~~'~" "':_"'k;>,<~ :.: L...-._..-L:;;."'>',_,-",~""",_"""""'':;''',,,,' ,.~. ..;,." ;J.'-,-_,' '.:.~ ..~-; ,.,~ .....- '0";;;' ",~_,,*,_,''''.yT_'. .",.'_.-",.;.:,. _,',.cO'....,._ .,.~"" ..' ~ ,~.. -~"'.""..~ - -_. -., 1. COUNTY OF YORK ) ) SS: ) COMMONWEAL TH OF PENNSYLVANIA We,Cnni,hro. A.lY\<l~, l~ and j2DbrtClo~"e. witnesses, whose names are signed the attached or foregomg Instrument, being duly qualified according to law, do depose and say that we were present and saw the Testatrix sign and execute the instrument as her Last Will; that the Testatrix signed willingly and executed it as her free and voluntary act for the purposes therein expressed; that each subscribing witness in the hearing and sight of the Testatrix signed the Will as witnesses; and that to the best of our knowledge, the Testatrix was at the time 18 or more years of age, of sound mind and under no constraint or undue influence. Sworn to or affirmed and subscribed to before me by Ch ri ~ i-t"nO-. A. (Vh~ U-l ~ and ~\oert- CJo-hn€- witnesses, this ) '8 'tl::- day of fY1/\ . ~ ' 2001. ~(l~ Witness \\J~~ "'--d!. R~ Nota Public Notarial Seal . Mlch@le L, Ramp, Notary Pubhc York. York County ! My Commission Expires Oct. 13, 2001 l."'__...........,;tf. ;p..''',."...~~~,.,..''''-- -6-